Apparatus for applying surgical fasteners

Description

BACKGROUND OF THE INVENTION

1. Field of the Invention

[0001] The present invention relates to surgical instruments for applying surgical fasteners or staples to body tissue, and more particularly to an apparatus for applying surgical fasteners having adjustable mechanisms for controlling the spacing between the jaw members through which the tissue passes during the fastening or stapling procedures. Such an instrument is disclosed in US-A-2891250, on which the pre-characterising part of claim 1 below is based.

2. Discussion of the Related Art

[0002] Surgical fastening devices having means for controlling the spacing between the jaw members are well known in the art. These devices typically include indicating means to provide a reading of the spacing between the jaw members. Devices are also known in the art which provide latching mechanisms to actuate the firing mechanism only when the distance between the jaws is within a preset range. These devices typically include a complex lock-out mechanism.

[0003] Various closing mechanisms are provided in the prior art for use with surgical fastening devices. The most notable of these devices utilize a complex worm gear-type arrangement or screw bearing member to open and close the spacing between the jaw members of the surgical fastening apparatus. These devices generally provide a rotatable knob or wing-like assembly at the trigger end of the device remote from the jaw mechanism which carries the fastener cartridge, and a screw-like mechanism is provided that passes through the body of the device to translate the rotational movement of the knob into longitudinal movement of the cartridge frame to open and close the spacing between the jaws. As the jaw members are closed around a tissue site to which fasteners are to be applied, the surgeon must grasp the device with one hand while rotating the knob or wing-like assembly with the other hand. As the jaws members close about the tissue to pinch the tissue therebetween, the surgeon then ceases rotation and activates the trigger mechanism to drive the fasteners into the tissue. Several known devices provide a trigger-like mechanism, while others provide a secondary rotatable knob for driving the fasteners by rotational movement. Many devices provide an indicator means near the rotatable knob which gives a visual indication of the spacing between the jaw members prior to firing.

[0004] These prior art devices are subject to several disadvantages in both use and construction which render these devices difficult to operate and expensive to manufacture. Many of the devices are cumbersome in use in that the surgeon must operate the device with both hands, holding the body of the instrument in one hand while rotating the knob or wing assembly with the other hand. This may lead to inaccurate stapling or fastening since the surgeon is unable to guide the tissue to be stapled or fastened with his free hand while closing the jaws about the tissue. Furthermore, the number of interacting components provides inaccuracies due to normal break down of tolerances. In addition, the gear arrangement may become worn during extended use, thus rendering an imprecise grasping action at the jaws.

[0005] Furthermore, these prior art devices generally involve a complex construction in which a precisely machined or cast worm gear must be constructed and incorporated into the device. This of course increases the cost of manufacturing, and requires a sophisticated assembly procedure to properly locate the worm gear in the instrument to control the spacing between the jaws.

[0006] Typical devices having a rotatable knob at the end portion adjacent the handle mechanism of the surgical stapling or fastening device are disclosed in, among others, U.S. Patent No. 4,930,503 to Pruitt, U.S. Patent No. 4,788,978 to Strekopytov et al., and U.S. Patent No. 4,606,344 to DiGiovanni. In each of these devices, an elongated rod member having screw threads machined thereon is provided, which connects a rotatable knob positioned adjacent the handle members to a pusher mechanism which urges a movable jaw in a forward direction toward a stationary jaw to close the spacing between the jaw members. When a desired spacing is reached, a trigger mechanism may be activated to fire the fasteners through the tissue into the anvil member mounted on the stationary jaw. To remove the fastening instrument after application of the fasteners, the knob is rotated in an opposite direction which turns the screw threaded rod member to move the movable jaw member away from the stationary jaw member so that the entire device maybe removed from the tissue.

[0007] Surgical fastening instruments having a wing like arrangement positioned adjacent the handle assembly of a device for moving a movable jaw toward a stationary jaws for affixing surgical fasteners to tissue are disclosed in U.S. Patent No. 4,442,964 to Becht, U.S. Patent No. 4,354,628 to Green, and U.S. Patent No. 3,795,034 to Strekopytov et al. These devices are similar to those described above except for the provision of a rotatable wing member in place of the rotatable knob. These devices are also provided with a screw threaded rod member which, when rotated, urges a movable jaw towards a stationary jaw to close the jaw members around tissue to be fastened together. After the application of surgical fasteners, the wing assembly is rotated in an opposite direction to draw the movable jaw away from the stationary jaw so that the instrument maybe removed from the tissue.

[0008] Surgical stapling of fastening instruments having a pivotable mechanism external to the device for moving a movable jaw toward a stationary jaw prior to affixing surgical fasteners to tissue are disclosed in, among others, U.S. Patent No. 3,269,630 to Fleischer, U.S. Patent No. 4,530,453 to Green, U.S. Patent No. 4,715,520 to Roehr, Jr. et al., and U.S. Patent No. 4,978,049 to Green.

[0009] Green ('453), Roehr, Jr. et al. and Green ('049) each disclose a pivotable lever member which urges a movable jaw into proximity of a stationary jaw prior to application of the surgical fasteners. Fleischer discloses a surgical stapling instrument in which a pivotable handle urges the movable staple cartridge against the tissue in the direction of the stationary jaw and fires the staples in the same motion. In each of these devices, removal of the instrument after firing of the surgical fasteners is accomplished by pivoting the lever mechanism in the opposite direction to open the jaw members by moving the movable jaw away from the stationary jaw.

[0010] EP-A-0479131, based on US patent application serial No. 593,697 discloses a spring biased pivotal catch member for approximating the jaws which is held in selected position by a pointed lance member. It is an earlier unpublished application which has to be considered under Article 54(3) EPC.

[0011] The novel surgical stapling or surgical fastening device of the present invention obviates the disadvantages encountered in the prior art and provides an efficient surgical fastening device having an adjustable closure mechanism for controlling the spacing between the jaw members of the surgical fastening apparatus. The device of the present invention allows a surgeon to operate a surgical fastener with one hand while freeing the other hand to assist in the surgical procedure. Furthermore, the present invention provides a novel means for coupling the fastener driving mechanism to the firing mechanism when the jaws are approximated to a preset distance. The device of the present invention can be of lightweight construction and can provide ease of handling through the provision of a thumb-controlled adjustable closure mechanism which permits a surgeon to set the spacing between the jaw members and fire the device while using only one hand.

SUMMARY OF THE INVENTION

[0012] The essential technical features of the invention are recited in claim 1 below.

[0013] The present invention provides a surgical fastening device having a novel mechanism for adjusting the distance between the movable jaw and the stationary jaw prior to the application of fasteners to the body tissue. The adjustable mechanism controls the closing of the jaw mechanism to approximate the distance between the jaw members prior to activation of the trigger mechanism to fire the fasteners. The device of the present invention may be operated with one hand, which frees the surgeon to accurately locate the tissue to be repaired and to place the fasteners in the proper position during the procedure. In one embodiment, the adjustable closure mechanism is operable by using the thumb of the hand which holds the device, and linearly moves the stapling mechanism to properly approximate the distance between the jaw members. The adjustable closure mechanism of the present invention eliminates many moving parts associated with prior devices, and can provide a device which is lightweight, and easy to use by allowing the surgeon to set and release the device with one hand.

[0014] The present invention can be embodied as a surgical instrument having jaw members which comprise a stationary jaw and a movable jaw, or two movable jaws, in which the spacing between the jaw members is adjustable to accommodate various thicknesses of tissue to be secured. The provision of a push button at the handle end of the instrument, and the elimination of numerous complex moving parts which are common in prior art devices, allows the surgeon to approximate the distance between the jaw members in a fast and efficient manner to position the jaws in the proper alignment for the application of surgical fasteners.

[0015] The apparatus of the present invention may comprise a first jaw member and a second jaw member in which the first jaw member includes a plurality of fasteners positioned in a cartridge which is movable with the first jaw member towards the stationary second jaw member. The second jaw member may include an anvil surface for clinching the fasteners, or may include means for engaging the fasteners to secured the tissue therebetween. Means for advancing the first jaw member towards the second jaw member to grip the tissue between the jaws are provided, as well as releasable means for retaining the advancing means along a linear path of travel to selectively position the first jaw member in relation to the second jaw member. Means for driving the fasteners into the tissue subsequent to positioning the jaws members in relation to each other by the advancement means is also provided, and the advancement means of the apparatus of the present invention is independent of the driving means.

[0016] In a preferred embodiment a push button mechanism is provided at the handle end of the device which may be linearly displaced by the thumb of the surgeon. As the push button and slider bar arrangement is urged forwardly towards the jaws, the releasable retaining means is also urged forwardly within the housing of the apparatus to selectively position the jaw members in relation to each other. As the slider bar and releasable retaining means are continuously moved forward, a linkage arrangement is activated which urges the cartridge frame forward so that the cartridge moves towards the anvil. When the linkage arrangement is fully actuated, the proper distance between the jaw members is set, so that the trigger mechanism may be actuated to drive the fasteners through the tissues.

[0017] Preferably, a coupling mechanism is provided which couples the fastener driving means to the trigger mechanism to allow for driving of the staples or fasteners when the proper distance between the jaw members is set. As the slider mechanism is moved forward and the linkage arrangement actuated, the fastener driving means is urged forwardly with the cartridge frame. A coupling arm, which is connected at one end to the trigger mechanism, slides along a bearing surface on the driving means until the slider mechanism is fully deployed. At this point, a camming edge of the coupling arm engages a notch in the bearing surface of the driving means to couple the trigger mechanism to the driving means. At this point, the proper distance between the jaw members is set and the fastener means may be driven into the tissue.

[0018] After the fastening means have been driven into the tissue, the releasable retaining mechanism may be disengaged so that the jaw members may be returned to their original position whereby the fastening device may be removed from the surgical site. In the preferred embodiment, the push button is pivotable to move a second rod member which contacts a release lever which disengages the retaining means. In a second embodiment, a release knob is provided which extends through the housing of the fastening apparatus and which may be pivoted to release the retaining means.

BRIEF DESCRIPTION OF THE DRAWINGS

[0019] The foregoing features of the present invention will become more readily apparent and may be understood by referring to the following detailed description of an illustrative embodiment of the surgical fastening instrument and its novel adjustable closure mechanism, taken in conjunction with the accompanying drawings, in which:

Fig. 1 illustrates a perspective view of a surgical fastening instrument which embodies the present invention;

Fig. 2 illustrates a side Cross-sectional plan view of a surgical fastening instrument which embodies the present invention, in which the instrument is in an at rest condition;

Fig. 3 illustrates the device of Fig. 2 in which the adjustable closure mechanism is activated and the jaw mechanism is partially closed;

Fig. 4 illustrates the device of Fig. 2 in which the adjustable closure mechanism is fully deployed;

Fig. 5 illustrates the device of Fig. 2 in which the adjustable closure mechanism is fully deployed and the trigger mechanism of the device has been actuated so that the fastening means have been driven from the cartridge;

Fig. 6 illustrates a partial enlarged view of the handle end of the device of Fig. 2 showing the release mechanism for disengaging the retaining means

Fig. 7 illustrates the retaining means at the handle end of the device of Fig. 2 in the at rest condition;

Fig. 8 illustrates a top plan cutaway view of the instrument of Fig. 1 showing the adjustable closure mechanism in the at rest condition;

Fig. 9 shows a top plan cutaway view of the instrument of Fig. 1 showing the adjustable closure mechanism in the fully deployed condition;

Fig. 10 illustrates a perspective view of the surgical fastening apparatus employing an alternative embodiment of the adjustable closure mechanism;

Fig. 11 illustrates a side cutaway view of the handle end of the instrument of Fig. 10 showing the adjustable closure mechanism;

Fig. 12 illustrates a top plan cutaway view of the device of Fig. 10 showing the linkage arrangement of the adjustable closure mechanism in an at rest condition;

Fig. 13 illustrates a top plan cutaway view of the device of Fig. 10 showing the linkage arrangement of the adjustable closure mechanism in a fully deployed condition;

Figs. 14A-14C illustrate the mechanism for coupling the trigger mechanism to the fastener driving mechanism in conjunction with the adjustable closure mechanism; and

Figs. 15A and 15B illustrate embodiments of the retaining means of the adjustable closure mechanism

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0020] Referring now in specific detail to the drawings, in which like reference numerals identify similar or identical elements throughout the several views, Fig. 1 shows a surgical fastening instrument 10 which employs an adjustable closure mechanism. Fastening instrument 10 is provided with a stationary handle 12 and an actuating handle 14 which together comprise the trigger mechanism of instrument 10. An elongated body portion 16 is provided which terminates in a distal jaw mechanism 18 which includes an anvil jaw 20 and a cartridge jaw 22. A fastening cartridge (not shown) is positioned within cartridge jaw 22 for driving staples or fasteners through tissue against an anvil surface positioned on anvil jaw 20. Alternatively, the cartridge can contain the fastener portions of two part fasteners which are driven into retainers positioned on the anvil jaw. At the handle end of instrument 10 is provided a push button 26 for operating an advancement mechanism 28, whose function will be described below.

[0021] As seen in Fig. 2, push button 26 and advancing mechanism 28 extend outwardly from the handle end of the instrument 10. A releasable retaining mechanism 32 is slidably engaged to the stationary rod member 36 and is coupled to slider mechanism 40 so that as slider mechanism 40 is urged forwardly into housing 30, retaining mechanism 32 is slidably retained along stationary rod member 36.

[0022] Advancing mechanism 28 comprises slider mechanism 40 and release rod member 38, such that release rod member 38 and slider mechanism 40 are secured to push button 26. Thrusting push button 26 towards housing 30 slides release rod 38 and slider mechanism 40 into the housing to move the retaining mechanism 32 along rod 36. Slider mechanism 40 extends to linkage structure 42 to activate the linkage structure 42 and urge jaw mechanism 18 distally. Linkage structure 42 moves movable rod 34, as well as fastener driver 56, cartridge frame 44, alignment pin advancement means 24, and cartridge 54 all in a distal direction to selectively position movable cartridge jaw 22 and stationary anvil jaw 20.

[0023] For purposes of clarity, the individual mechanisms will be described separately, and then the overall operation of the device will be discussed.

[0024] Fig. 7 illustrates the retaining mechanism, which slidably engages the stationary rod 36, and which acts in conjunction with the linkage structure 42 to selectively position the jaw mechanism 18 of the surgical fastener apparatus 10. Retaining mechanism 32 is coupled to slider mechanism 40 and is urged rearwardly by biasing spring 80 as shown. The retaining mechanism 32 essentially comprises a clamp member 68 which is provided with a central bore 128 through which stationary rod 36 passes. Clamp member 68 is best seen in Fig. 15A. Retaining mechanism 32 further comprises a block member 70 to which clamp member 68 is pivotally secured and biased into a locking engagement of stationary rod 36 by spring member 81. Spring member 81 may comprise a coiled spring as shown, or may further comprise any other biasing mechanism such as a leaf spring, rubber block, or the like. Block member 70 may be provided with a central bore (not shown) through which stationary rod 36 passes, or alternatively, block member 70 may have a substantially U-shaped portion to allow stationary rod 36 to pass therethrough. Block member 70 further comprises shoulder portion 72 which abuts the lower portion of clamp member 68 as shown to provide a pivot point for releasing clamp member 68, as will be described below.

[0025] As best seen in Fig. 15A, clamp member 68 has an L-shaped portion terminating in a contact face 73 which engages a release lever 74, which is pivotably connected to carriage 76 and which pivots about pivot point 79. Release lever 74 preferably has a central bore to allow a stationary rod 36 to pass therethrough, but may also be provided with a U-shaped body both to surround stationary rod 36 and engage contact face 73 of clamp member 68. Clamp member 68 is further provided with a guide post 82 which slides within a guide track 83 to fully align clamp member 68 in relation to stationary rod 36.

[0026] As shown in Fig. 7, clamp member 68 is biased at an angle to engage stationary rod 36 so that edges of central bore 128 frictionally engage stationary rod member 36. As push button 26 is urged towards housing 30, retaining mechanism 32 slides along stationary rod 36 due to the movement of advancing mechanism 28. Carriage 76 is engaged with movable slider mechanism 40 so that the entire retaining mechanism is urged distally against biasing spring 80. In order to release retaining mechanism 32, as best shown in Fig. 6, push button 26 is rotated in the direction of arrow E until beveled surface 27 contacts housing 30. Pivoting push button 26 in the direction of arrow E moves release rod 38 in the direction of arrow F so that contact surface 78 of release rod 38 pivots release lever 74 to engage contact face 73 of clamp member 68. This pivoting action moves clamp member 68 in the direction of arrow G to release the frictional engagement of the central bore 128 with stationary rod 36. Releasing the frictional engagement causes the entire retaining mechanism 32 to return in the direction of arrow G to the position shown in Fig. 7. This movement is caused by biasing spring 80 (not shown in Fig. 6) which moves the entire mechanism to the position shown in Fig. 7.

[0027] Turning now to Figs. 8 and 9, there is illustrated the linkage structure 42 and its operation in conjunction with slider mechanism 40 and retaining mechanism 32. Structure 42 comprises a pair of linkage arms 84, which are preferably secured by pivot posts to a second pair of linkage arms 84 located below the pair shown in Fig. 8 in mirror arrangement, as clearly shown in Figs. 2-6. Linkage arms 84 are joined through stationary pivot post 86, and movable pivot posts 88A and 88B. Movable pivot post 88A is secured to rod 34 and cartridge frame 44 to urge these elements distally when push button 26 is activated. Slider mechanism 40 includes a camming surface 90 which engages movable pivot post 88B to collapse linkage structure 42 to move the rod 34 and cartridge frame 44, and consequently move cartridge jaw 22 towards anvil jaw 20.

[0028] As best seen in Fig. 9, as push button 26 is fully actuated to contact housing 30, retaining mechanism 32, being coupled to slider mechanism 40 slides along stationary rod 36. Camming surface 90 engages movable post 88B, driving movable post 88A distally to move movable rod 34 and cartridge frame 44 in relation to housing frame 21 as shown. Releasing-retaining mechanism 32 as described above returns linkage structure 42 to the configuration shown in Fig. 8.

[0029] It can be appreciated from Figs. 8 and 9 that the linkage structure 42 provides a two-stage approximation of the jaw mechanism 18, whereby initial movement of the slider mechanism 40 caused a large initial approximation, while a smaller, secondary approximation eases the jaws into approximation at the conclusion of movement of the slider mechanism 40. As slider mechanism 40 is initially moved upon actuation of the push button 26, a large portion of the overall distance cartridge jaw member 22 travels towards anvil jaw member 20 is traversed in the initial movement. Typically, as the slider mechanism 40 travels approximately one-half its overall distance, and correspondingly moving movable pivot post 88A a portion of its total distance, cartridge jaw 22 moves approximately 80% of its total distance. As slider mechanism 40 travels its remaining one-half distance, the cartridge jaw moves its final 20% of its total distance. This allows for a fine adjustment of the jaw mechanism to accommodate the various thickness of tissues positioned between the jaw members.

[0030] Instrument 10 employing the adjustable closure mechanism may further include a coupling device for coupling the fastener driving mechanism to the trigger mechanism only when a proper distance between cartridge jaw 22 and anvil jaw 20 has been reached. This mechanism is best illustrated in Figs. 14A through 14C.

[0031] Figs. 14A through 14C, in conjunction with Figs. 2-6, illustrate the coupling mechanism Housing frame 21 is provided with a frame track 52 within which a driving pin 50 rides. Driving pin 50 is secured to one leg of an L-shaped driving link 48, where the opposite end of driving link 48 is secured to the alignment pin advancement means 24. Driving link 48 is further coupled to cartridge frame 22 which is advanced distally when push button 26 is actuated. As push button 26 is actuated, linkage structure 42 is deployed and fastener driver 56 is moved distally. Prior to actuation of push button 26, fastener driver 56 is in the position shown in Fig. 14A, and coupling arm 58 is positioned on bearing surface 61 as shown. Coupling arm 58 is connected to actuating handle 14 as best seem in Fig. 2.

[0032] As push button 26 is moved, fastener driver 56 is moved forwardly so that coupling arm 58 slides along bearing surface 61 as shown in Fig. 14B. Driving pin 50 travels in frame track 52, while driving link 48 urges alignment pin advancement means 24 as shown. As best seen in Fig. 3, alignment pin advancement means 24 moves forwardly so that alignment pin 62 protrudes from cartridge 54 and aligns with an alignment hole (not shown) in anvil jaw 20. This insures proper alignment of cartridge 54 with anvil jaw 20 so that fastener means 66 are properly driven into position between the jaw members.

[0033] As push button 26 is further moved towards housing 30, to the position shown in Fig. 4, cartridge jaw 22 is aligned adjacent anvil jaw 20 so that pin 62 is within the hole in anvil jaw 20. Driving link 48 moves slightly in the proximal direction towards the handle end of instrument 10 to a substantially upright position as shown in Fig. 14C and Fig. 4. This moves alignment pin advancement means 24 slightly proximally to the position shown in Fig. 4 so that alignment pin 62 does not protrude completely through anvil jaw 20.

[0034] When push button 26 reaches the position shown in Fig. 4, fastener driver 56 has moved distally to a position where coupling arm 58 slides off bearing surface 61 and into notch 60 as shown in Fig. 14C. At this point, driving link 48 has moved to the position shown in Fig. 14C and driving pin 50 has fully traversed the length of frame track 52. In the position shown in Fig. 14C, coupling am 58 is engaged with fastener driver 56 so that actuation of handle 14 as shown in Fig. 5 will drive fastener means 66 into the tissue as fastener driver 56 moves in the direction of arrow D. Although not shown, coupling arm 58 may be provided with a leaf spring member to urge coupling arm 58 into engagement with notch 60. As push button 26 is rotated to release retaining mechanism 32, driving pin 50 travels proximally in frame track 52, so that when driving pin 50 reaches the position shown in 14B fastener driver 56 is lifted off coupling arm 58 despite the leaf spring, and coupling am 58 is no longer engaged in notch 60. As retaining means 32 returns the entire mechanism to the position shown in Fig. 2, driving link 48 and fastener driver 56 return to the position shown in Fig. 14A.

[0035] Returning now to Figs. 2 through 6, the operation of the surgical fastener apparatus 10 will now be described.

[0036] After tissue which is to be surgically repaired is positioned between cartridge jaw 22 and anvil jaw 20, push button 26 is pushed in the direction of arrow A as seen in Fig. 3 which moves slider mechanism 40 and release rod 38 into housing 30. Retaining mechanism 32 is slid distally along stationary rod 36, and camming surface 90 of slider mechanism 40 engages stationary post 88B to deploy linkage structure 42. As linkage structure 42 is deployed, movable rod 34 is urged forwardly along with cartridge frame 44, thus urging driving pin 50 along frame track 52. The force of biasing spring 46 is overcome as push button 26 is urged in the direction of arrow A.

[0037] As driving pin 50 moves in track 52, driving link 48 is moved to the position shown in Fig. 3, which urges alignment pin advancement means 24 to the position shown at the jaw mechanism 18. In this position, alignment pin 62 protrudes from cartridge 54 and aligns with the alignment hole in anvil jaw 20 as cartridge 54 moves in the direction of arrow A'.

[0038] As linkage structure 42 is deployed and movable rod 34 and cartridge frame 44 move distally, fastener driver 56 also moves distally and coupling arm 58 slides along bearing surface 61.

[0039] When push button 26 is fully actuated, linkage structure 42 is fully deployed as shown in Fig. 4, and retaining mechanism 32 frictionally engages stationary rod 36 to maintain instrument 10 in the position shown in Fig. 4. At this time, cartridge 54 has moved into position in the direction of arrow A' so that alignment pin 62 is positioned in the alignment hole in anvil jaw 20. Alignment pin advancement means 24 moves slightly proximally so that alignment pin 62 does not protrude beyond anvil jaw 20, and driving link 48 assumes the position shown in Fig. 4. Driving pin 50 has reached the end of track 52. In the position shown in Fig. 4, actuating arm 58 has slid off bearing surface 61 and into notch 60 of fastener driver 56 so that the device as shown in Fig. 4 is ready to be fired. Once in the position of Fig. 4, actuating handle 14 is moved in the direction of arrow B to fire the fasteners 66. As actuating handle 14 is moved in the direction of arrow B against the force of biasing spring 64, coupling arm 58, having been engaged in notch 60, moves in the direction of arrow C to move fastener driver 56 distally in the direction of arrow D. Fastener driver 56 drives fasteners 66 from cartridge 54 through the tissue (not shown) and into the anvil surface of anvil jaw 20. Upon completion of firing, actuating handle 14 is released and returns to the position shown in Fig. 4.

[0040] To remove instrument 10 from the surgical site, it is necessary to release the jaw mechanism 18 to return to the position shown in Fig. 2. This is accomplished by pivoting push button 26 in the direction of arrow E, as best seen in Fig. 6, so that beveled surface 27 contacts the housing 30. As push button 26 is pivoted in the direction of arrow E, release rod 38 travels in the direction of arrow F so that contact surface 78 of release rod 38 pivots release lever 74 as shown, which engages contact face 73 to move clamp member 68 to an upright position and perpendicular in relation to stationary rod 36. This releases the frictional engagement of clamp member 68 with stationary rod 36 and the entire retaining mechanism 32 is moved along stationary rod 36 in the direction of arrow G due to the force of biasing spring 80 (as shown in Fig. 7). The entire mechanism, including the linkage structure 42, jaw mechanism 18, and retaining mechanism 32 is returned to the position shown in Fig. 2.

[0041] Fig. 10 illustrates a surgical fastening apparatus 100 employing an alternative adjustable closure mechanism. Apparatus 10 is similar to apparatus 10 of Fig. 1 in that a stationary handle 12 and an actuating handle 14 are provided, along with a body portion 16 and a jaw mechanism 18. Body portion 16 is provided with a flared portion 104 which is symmetrical on both sides of the instrument for accommodating the slider mechanism which will be described below. A push button 102 is provided for actuating the slider mechanism, and a release button 106 is provided to release the retaining mechanism as will be described below.

[0042] Turning now to Fig. 11, there is shown the adjustable closure mechanism of the apparatus of Figure 10. Instrument 100 is substantially identical to instrument 10 except for retaining mechanism 101 and linkage structure 110.

[0043] Linkage structure 110 comprise a plurality of linkage arms 112, as best seen in Fig. 12. Linkage arms 112 form a collapsible box structure having a mirror image as shown in Fig. 11. Linkage arms 112 are joined by stationary pivot post 114 and movable pivot posts 115. As seen in Fig. 12, movable pivot post 115A is secured to movable rod 116 whose function will be described below. Push button 102 is connected to slider mechanism 108 which is provided with an essentially Y-shaped configuration. The outer ends of the Y-shaped slider mechanism are accommodated in flared portions 104 of the housing 103 of instrument 100. Movable rod 116 extends from movable pivot point 115A through retaining mechanism 101 to connect to fastener driver 56 and cartridge frame 44 as shown. Movable rod 116 is frictionally engaged by retaining mechanism 101 to selectively position cartridge jaw 22 in relation to anvil jaw 20.

[0044] Retaining mechanism 101 comprises clamp member 122 and block member 118 which is provided with shoulder 120. Clamp member 122, as best seem in Fig. 15B, is provided with a central bore 128 whose edges frictionally engage movable rod 116. Movable rod 116, as well as stationary rod 36 of the embodiment of Figs. 1-9, may be provided with a scored surface to enhance the frictional gripping of clamp members 122 and 68. Clamp member 122 is biased into the engaged position by biasing spring 124.

[0045] In use, push button 102 is urged distally towards housing 103 so that camming surfaces 126 engage movable pivot posts 115. As linkage structure 110 collapses to the position shown in Fig. 13, movable pivot point 115A urges movable rod forwardly through retaining mechanism 101 to move fastener driver 56 and cartridge frame 44 distally to selectively position the jaw mechanism. When push button 102 is in the position shown in Fig. 13, linkage structure 110 is fully collapsed as shown and movable rod 116 is frictionally secured by clamp member 122.

[0046] As seen in Fig. 11, a handle locking mechanism 130 may also be provided. To fire the device to drive fasteners through tissue positioned in jaw mechanism 118, locking mechanism 130 is pivoted away from actuating handle 114 and the fasteners are driven through the tissue in the manner described above. To return instrument 100 to the position shown in Fig. 11, release knob 106 is moved in the direction of arrow H so that clamp member 122 is pivoted about shoulder 120. When clamp member 122 reaches a substantially vertical position perpendicular to movable rod 116, the frictional engagement between the central bore 128 and the movable rod 116 is released, and movable rod 116 returns to the position shown in Fig. 11 due to a biasing spring which is not shown. Release knob 106 is then let go of, and biasing spring 124 returns clamp member 122 to the position shown in Fig. 11. Linkage structure 110 returns to the position shown in Fig. 12.

[0047] As described above in connection with linkage structure 42, movement of linkage structure 110 provides for a two-stage approximation of the jaw mechanism, providing for a large approximation (about 80% of the total distance) of the jaw distance for movement of the first 50% of the slider mechanism 108. The remaining 50% of the movement of the slider mechanism 108 moves the jaw mechanism 18 its remaining 20% of distance, providing for fine adjustment.

[0048] The described adjustable closure mechanism can also be used in surgical fastening instruments other than those illustrated, to close the distance between the movable jaw member and stationary jaw member at the stapling or fastening end of the instrument or between two movable jaw members. The jaw mechanism may be of the type wherein one jaw moves toward and away from the other or of alternative types, i.e., where both jaws move toward and away from each other. The surgical instrument may be of the, type which applies metal staples or two part fasteners of the bioabsorbable type.

[0049] The surgical stapling or fastening instrument employing the described adjustable closure mechanism is a device which may be operated with one hand to effect the closure motion of the jaw members of the instrument followed by activation of the trigger mechanism to fire the staples or fasteners into the tissue. The complex rotational or pivoting arrangement of the prior art devices is eliminated, opening up the possibility of a lightweight and easy to handle instrument which is inexpensive to manufacture and easy to assemble.

[0050] The claims which follow define further embodiments within the scope of the invention.

Claims

1. Hand-held surgical fastening apparatus (10) for application of surgical fasteners to body tissue, comprising:

tissue gripping means including a first jaw member (22) and a second jaw member (20), said first jaw member including a plurality of fasteners (66) positioned thereon;

first hand-operable means (28), for advancing one of said jaw members towards said other jaw member to grip tissue therebetween prior to driving said fasteners (66) into said tissue;

means (32) for retaining said advancing means at a chosen point along a linear path of travel, to selectively position said jaw members in relation to each other; and

second hand-operable means (56), distinct from the first means (28), for driving said fasteners (66) into said tissue subsequent to positioning said jaw members (20, 22) in relation to each other by said advancing means;
characterised by:

i. a biasing means (80) which urges said one jaw (22) to move away from said other jaw (20);

ii. third hand-operable means (38), distinct from both the first and the second hand-operable means, to release the retaining means (32), to permit said one jaw (22) to move away from said other jaw (20) under the urging of the biasing means (80);

iii. a trigger mechanism comprising a stationary handle (12) by which the apparatus is held and an actuating handle (14) to receive finger pressure to urge it towards the stationary handle (12) for actuation of the fastener driving means (56); and

iv. the third means (38) being hand-operable by the user while holding the stationary handle, whereby the user can, in sequence, with only one hand, advance the first jaw to the chosen point, drive the fasteners (66) into said tissue, and then release the tissue from the jaws.

2. Apparatus according to claim 1, wherein the release means comprises a pivotable knob (26, 106), associated with said retaining means (32) for disengaging said retaining means from said advancing means to return said advancing means to a rest position.

3. Apparatus according to any one of the preceding claims further comprising coupling means (58, 60), for coupling said driving means to said actuating means, only when said first jaw member is approximated a predetermined distance towards said second jaw member.

4. Apparatus according to claim 3 wherein said coupling means comprises a bearing surface (60) on said driving means for engaging an arm member (58) of said actuating means for driving said fasteners only when said first jaw member is approximated to said predetermined distance towards said second jaw member, said bearing surface comprising a notch (60) for engaging said arm member (58), said notch extending from a sliding surface (61) on said driving means upon which said arm member rides prior to engaging said notch.

5. Apparatus according to any one of the preceding claims, further comprising cartridge means (54) for accommodating said plurality of fasteners, said cartridge means being releasably secured to said first jaw member (22) and further comprising means (24, 62) associated with said advancing means for guiding and aligning said cartridge means with said second jaw member.

6. Apparatus according to claim 5, wherein said guide means comprises a slide bar (24) secured at a proximal end through a linking arrangement (48) to said advancing means, and at a distal end to a guide pin (62) which passes through said cartridge means and said second jaw member to align said cartridge means and second jaw member.

7. Apparatus according to any one of the preceding claims wherein said advancing means (28) advances said first jaw member (22) towards said second jaw member (20) an initial distance followed by a secondary distance, said initial distance being greater than said secondary distance.

8. Apparatus according to any one of the preceding claims wherein said second jaw member (20) includes either an anvil surface for bearing against said fasteners or means for holding a plurality of retainers having means for receiving fasteners.

9. Apparatus according to claim 1 wherein said advancing means (28) is linearly slidable and comprises a rod member (40, 108) extending distally through a housing of said apparatus and being thumb-actuable (26, 102) by an operator to advance said first jaw member.

10. Apparatus according to claim 9 wherein said rod member is scored to provide an enhanced gripping surface for said retaining means to retain said rod member.

11. Apparatus according to claim 9 or 10, wherein said rod member terminates within said housing in a linkage structure (110), said linkage structure comprising a plurality of pivoting arm members (112) being collapsible during advancement of said advancing means to advance said first jaw member towards said second jaw member, said arm members pivoting about post members (114, 115) to collapse said structure and reform said structure during reciprocatory movement of said advancing means.

12. Apparatus according to claim 11, further comprising a linkage slider mechanism (108) for collapsing said linkage structure to advance said rod member to urge said first jaw member towards said second jaw member, said slider mechanism comprising at least one camming surface (126) for engaging said linkage structure.

13. Apparatus according to claim 12 wherein said slider mechanism extends beyond said housing of said apparatus and terminates in a push button member (102).

14. Apparatus according to claim 12 or 13, wherein said retaining means (122) is coupled to said advancing means (116), such that said retaining means moves within said housing upon movement of said slider mechanism, means (106) being provided for disengaging said retaining means to return said apparatus to a rest position.

15. Apparatus according to any one of the preceding claims, wherein said disengaging means comprises a movable rod member (38) coupled to a push button member (26), said push button member being pivotable to advance said movable rod to contact and disengage said retaining means to return said apparatus to said rest position.

16. Apparatus according to any one of the preceding claims wherein said retaining means comprises a pivotable clamp member (68, 122).

17. Apparatus according to claim 16 wherein said advancing means further comprises a stationary guide rod (36), said pivotable clamp member (68) being slidingly secured to said stationary guide rod, such that said clamp member moves along and releasably retains said guide rod to selectively position said advancing means and said jaw members.

18. Apparatus according to claim 17, wherein said pivotable clamp member has a central bore (128) through which said advancing means (36) passes, and edge of said central bore engaging said advancing means to retain said advancing means and selectively position said first jaw member in relation to said second jaw member.

19. Apparatus according to claim 16, 17 or 18 wherein said clamp member is biased to an engaged position such that said clamp member is at an angle to said advancing means and further comprising release means (73, 74, 78) for disengaging said clamp member from said advancing means.

20. Apparatus as claimed in any one of the preceding claims, wherein said retaining means engages said advancing means and the releasing means disengages the retaining means from engagement with the advancing means.

Ansprüche

1. Handgehaltene chirurgische Befestigungsvorrichtung (10) zum Anbringen von chirurgischen Befestigern an Körpergewebe, umfassend:

- eine Gewebegreifeinrichtung umfassend ein erstes Klemmbackenelement (22) und ein zweites Klemmbackenelement (20), wobei das erste Klemmbackenelement eine Mehrzahl von Befestigern (66) umfaßt, die darauf angeordnet sind;

- eine erste handbetätigbare Einrichtung (28), um eines der Klemmbackenelemente in Richtung auf das andere Klemmbackenelement vorzurücken, um Gewebe dazwischen vor dem Eintreiben der Befestiger (66) in das Gewebe zu greifen;

- eine Einrichtung (32), um die Vorrückeinrichtung an einem vorgewählten Punkt entlang einer liniaren Wegstrecke zu halten, um selektiv die Klemmbackenelemente in bezug aufeinander anzuordnen; und

- eine zweite handbetätigbare Einrichtung (56) unterschiedlich zur ersten Einrichtung (28), um die Befestiger (66) in das Gewebe nach dem Anordnen der Klemmbackenelemente (20, 22) in bezug aufeinander durch die Vorrückeinrichtung einzutreiben;
gekennzeichnet durch

i. eine Vorspanneinrichtung (80), welche die eine Klemmbacke (22) drückt, damit sich diese von der anderen Klemmbacke (20) wegbewegt;

ii. eine dritte handbetätigbare Einrichtung (38) verschieden von sowohl der ersten als auch der zweiten handbetätigbaren Einrichtung, um die Halteeinrichtung (32) zu lösen, um es der einen Klemmbacke (22) zu gestatten, sich von der anderen Klemmbacke (20) unter dem Druck der Vorspanneinrichtung (80) wegzubewegen;

iii. einen Auslösermechanismus umfassend einen feststehenden Griff (12), durch den die Vorrichtung gehalten wird, und einen Betätigungsgriff (14), um Fingerdruck aufzunehmen, um ihn in Richtung des feststehenden Griffes (12) zur Betätigung der Befestigereintreibeeinrichtung (56) zu drücken; und wobei

iv. die dritte Einrichtung (38) durch den Benutzer handbetätigbar ist, während er den feststehenden Griff hält, wobei der Benutzer in einer Abfolge mit nur einer Hand die erste Klemmbacke zum gewählten Punkt vorrücken, die Befestiger (66) in das Gewebe eintreiben und dann das Gewebe von den Klemmbacken lösen kann.

2. Vorrichtung nach Anspruch 1, wobei die Löseeinrichtung einen drehbaren Knopf (26, 106) umfaßt, der der Halteeinrichtung (32) zugeordnet ist, um die Halteeinrichtung von der Vorrückeinrichtung zu lösen, um die Vorrückeinrichtung in eine Ruheposition zurückzuführen.

3. Vorrichtung gemäß einem der vorhergehenden Ansprüche weiter umfassend eine Kopplungseinrichtung (58, 60), um die Eintreibeeinrichtung mit der Betätigungseinrichtung nur dann zu koppeln, wenn das erste Klemmbackenelement eine vorbestimmte Entfernung in Richtung des zweiten Klemmbackenelementes angenähert ist.

4. Vorrichtung gemäß Anspruch 3, wobei die Kopplungseinrichtung eine Lagerungsoberfläche (60) auf der Eintreibeeinrichtung umfaßt, um in Eingriff zu treten mit einem Armelement (58) der Betätigungseinrichtung, um die Befestiger nur einzutreiben, wenn das erste Klemmbackenelement zu einem vorbestimmten Abstand in Richtung des zweiten Klemmbackenelements angenähert ist, wobei die Lagerungsoberfläche eine Nut (60) umfaßt, um in Eingriff zu treten mit dem Armelement (58), und sich die Nut von einer Verschiebeoberfläche (61) auf der Eintreibeeinrichtung erstreckt, auf der das Armelement vor dem in-Eingriff-Treten mit der Nut verfährt.

5. Vorrichtung gemäß einem der vorhergehenden Ansprüche, weiter umfassend eine Magazineinrichtung (54), um die Mehrzahl von Befestigern aufzunehmen, wobei die Magazineinrichtung lösbar am ersten Klemmbackenelement (22) befestigt ist und weiterhin eine Einrichtung (24, 62) umfaßt, die der Vorrückeinrichtung zugeordnet ist, um die Magazineinrichtung zu führen und mit dem zweiten Klemmbackenelement auszurichten.

6. Vorrichtung gemäß Anspruch 5, wobei die Führungseinrichtung eine Verschiebestange (24) umfaßt, die an einem proximalen Ende durch eine Verbindungsanordnung (48) an der Vorrückeinrichtung und an einem distalen Ende an einem Führungsstift (62) befestigt ist, der durch die Magazineinrichtung und das zweite Klemmbackenelement hindurchtritt, um die Magazineinrichtung und das zweite Klemmbackenelement auszurichten.

7. Vorrichtung gemäß einem der vorhergehenden Ansprüche, wobei die Vorrückeinrichtung (28) das erste Klemmbackenelement (22) in Richtung des zweiten Klemmbackenelements (20) eine Anfangsentfernung vorrückt, gefolgt durch eine zweite Entfernung, wobei die Anfangsentfernung größer als die zweite Entfernung ist.

8. Vorrichtung gemäß einem der vorhergehenden Ansprüche, wobei das zweite Klemmbackenelement (20) entweder eine Anschlagoberfläche zum Drücken gegen die Befestiger oder eine Einrichtung zum Halten einer Mehrzahl von Haltern mit Einrichtungen zur Aufnahme von Befestigern aufweist.

9. Vorrichtung gemäß Anspruch 1, wobei die Vorrückeinrichtung (28) linear verschiebbar ist und ein Stangenelement (40, 108) umfaßt, das sich in distaler Richtung durch ein Gehäuse der Vorrichtung erstreckt und daumenbetätigbar (26, 102) durch einen Bediener ist, um das erste Klemmbackenelement vorzurücken.

10. Vorrichtung gemäß Anspruch 9, wobei das Stangenelement mit Furchen versehen ist, um für eine verbesserte Greifoberfläche für die Halteeinrichtung zum Halten des Stangenelementes zu sorgen.

11. Vorrichtung gemäß Anspruch 9 oder 10, wobei das Stangenelement innerhalb des Gehäuses in einem Verbindungsaufbau (110) endet und der Verbindungsaufbau eine Mehrzahl von verschwenkenden Armelementen (112) umfaßt, die während des Vorrückens der Vorrückeinrichtung zusammengedrückt werden können, um das erste Klemmbackenelement in Richtung des zweiten Klemmbackenelementes vorzurücken, wobei sich die Armelemente um Stiftelemente (114, 115) verschwenken, um den Aufbau zusammenzudrücken und den Aufbau während der Rückwärtsbewegung der Vorrückeinrichtung wieder herzustellen.

12. Vorrichtung gemäß Anspruch 11, weiter umfassend einen Verbindungsverschiebermechanismus (108), um den Verbindungsaufbau zusammenzudrücken, um das Stangenelement vorzurücken, um das erste Klemmbackenelement in Richtung des zweiten Klemmbackenelements zu drücken, wobei der Verschiebermechanismus zumindest eine Verschiebeoberfläche (126) zum in-Eingriff-Treten mit dem Verbindungsaufbau umfaßt.

13. Vorrichtung gemäß Anspruch 12, wobei der Verschiebermechanismus sich über das Gehäuse der Vorrichtung hinaus erstreckt und in einem Druckknopfelement (102) endet.

14. Vorrichtung gemäß Anspruch 12 oder 13, wobei die Halteeinrichtung (122) an der Vorrückeinrichtung (116) so gekoppelt ist, daß die Halteeinrichtung sich innerhalb des Gehäuses auf eine Bewegung des Verschiebermechanismus hin bewegt, wobei eine Einrichtung (106) vorgesehen ist, um die Halteeinrichtung auszurücken, um die Vorrichtung in eine Ruheposition zurückzuführen.

15. Vorrichtung gemäß einem der vorhergehenden Ansprüche, wobei die Einrichtung zum Ausrücken ein bewegbares Stangenelement (38) umfaßt, das mit einem Druckknopfelement (26) gekoppelt ist, wobei das Druckknopfelement drehbar ist, um die bewegbare Stange vorzurücken, um in Kontakt zu treten mit der Halteeinrichtung und aus dieser auszurücken, um die Vorrichtung in die Ruheposition zurückzuführen.

16. Vorrichtung gemäß einem der vorhergehenden Ansprüche, wobei die Halteeinrichtung ein drehbares Klemmenelement (68), 122) umfaßt.

17. Vorrichtung gemäß Anspruch 16, wobei die Vorrückeinrichtung weiter umfaßt eine feststehende Führungsstange (36), wobei das drehbare Klemmenelement (68) verschiebbar an der feststehenden Führungsstange so befestigt ist, daß sich das Klemmenelement entlang der Führungsstange bewegt und diese lösbar festhält, um selektiv die Vorrückeinrichtung und die Klemmbackenelemente zu positionieren.

18. Vorrichtung gemäß Anspruch 17, wobei das drehbare Klemmenelement eine mittige Bohrung (128) besitzt, durch die die Vorrückeinrichtung (36) hindurchtritt, wobei eine Kante der mittigen Bohrung in Eingriff ist mit der Vorrückeinrichtung, um die Vorrückeinrichtung zu halten und das erste Klemmbackenelement in bezug auf das zweite Klemmbackenelement selektiv zu positionieren.

19. Vorrichtung gemäß Anspruch 16, 17 oder 18, wobei das Klemmenelement in eine Eingriffsposition so vorgespannt ist, daß das Klemmenelement in einem Winkel zur Vorrückeinrichtung ist, und weiter umfassend eine Löseeinrichtung (73, 74, 78), um das Klemmenelement von der Vorrückeinrichtung zu lösen.

20. Vorrichtung gemäß einem der vorhergehenden Ansprüche, wobei die Halteeinrichtung in Eingriff tritt mit der Vorrückeinrichtung und die Löseeinrichtung aus der Halteeinrichtung vom Eingriff mit der Vorrückeinrichtung ausrückt.

Revendications

1. Appareil d'attachement chirurgical (10) tenu à la main pour appliquer des attaches chirurgicales à des tissus corporels, comportant :

un moyen saisissant le tissu incluant un premier élément de mâchoire (22) et un deuxième élément de mâchoire (20), ledit premier élément de mâchoire incluant une pluralité d'attaches (66) positionnées sur celui-ci ;

un premier moyen (28) actionnable à la main, pour faire avancer l'un desdits éléments de mâchoires vers ledit autre élément de mâchoire pour saisir le tissu entre ceux-ci avant d'entraîner lesdites attaches (66) dans ledit tissu ;

un moyen (32) pour retenir ledit moyen d'avance à un point choisi le long d'un trajet de déplacement linéaire, pour positionner sélectivement lesdits éléments de mâchoire l'un relativement à l'autre ; et

un deuxième moyen actionnable à la main (56), distinct du premier moyen (28) pour entraîner lesdites attaches (66) dans ledit tissu à la suite du positionnement desdits éléments de mâchoire (20, 22) l'un relativement à l'autre par ledit moyen d'avance ;
   caractérisé par :

i. un moyen de sollicitation (80) qui sollicite une mâchoire précitée (22) au loin de l'autre mâchoire précitée (20) ;

ii. un troisième moyen actionnable à la main (38), distinct à la fois des premier et deuxième moyens actionnables à la main, pour libérer le moyen de retenue (32), pour permettre à la mâchoire précitée (22) de s'éloigner de l'autre mâchoire précitée (20) sous la sollicitation du moyen de sollicitation (80) ;

iii. un mécanisme de déclenchement comportant une poignée stationnaire (12) par laquelle l'appareil est tenu et une poignée d'actionnement (14) pour recevoir une pression exercée par un doigt pour la solliciter vers la poignée stationnaire (12) en vue de l'actionnement du moyen entraînant les attaches (56) ; et

iv. le troisième moyen (38) étant actionnable à la main par l'utilisateur pendant qu'il tient la poignée stationnaire, par quoi l'utilisateur peut faire avancer, en séquence, avec une main seulement, la première mâchoire au point choisi, entraîner les attaches (66) dans ledit tissu et libérer ensuite le tissu des mâchoires.

2. Appareil selon la revendication 1, dans lequel le moyen de relâchement comporte un bouton tournant (26, 106) associé audit moyen de retenue (32) pour mettre hors prise ledit moyen de retenue avec ledit moyen d'avance afin de ramener ledit moyen d'avance à une position de repos.

3. Appareil selon l'une des revendications précédentes, comportant en outre un moyen d'accouplement (58, 60), pour accoupler ledit moyen d'entraînement audit moyen d'actionnement seulement lorsque ledit premier élément de mâchoire est approché sur une distance prédéterminée dudit deuxième élément de mâchoire.

4. Appareil selon la revendication 3, où ledit moyen d'accouplement comporte une surface de palier (60) sur ledit moyen d'entraînement pour venir en prise avec un élément de bras (58) dudit moyen d'actionnement pour entraîner lesdites attaches seulement lorsque ledit premier élément de mâchoire est approché de ladite distance prédéterminée vers ledit deuxième élément de mâchoire, ladite surface de palier comportant une encoche (60) pour la mise en prise avec ledit élément de bras (58), ladite encoche s'étendant depuis une surface de coulissement (61) sur ledit moyen d'entraînement sur laquelle ledit élément de bras se déplace avant de s'engager dans ladite encoche.

5. Appareil selon l'une des revendications précédentes, comportant en outre un moyen de cartouche (54) pour loger ladite pluralité d'attaches, ledit moyen de cartouche étant fixé relâchablement audit premier élément de mâchoire (22) et comportant en outre un moyen (24, 62) associé audit moyen d'avance pour guider et aligner ledit moyen de cartouche avec ledit deuxième élément de mâchoire.

6. Appareil selon la revendication 5, dans lequel ledit moyen de guidage comporte une barre coulissante (24) fixée à une extrémité proximale par un agencement à bielle (48) audit moyen d'avance, et à une extrémité distale à un axe de guidage (62) qui passe à travers ledit moyen de cartouche et ledit deuxième élément de mâchoire pour aligner ledit moyen de cartouche et le deuxième élément de mâchoire.

7. Appareil selon l'une des revendications précédentes, où ledit moyen d'avance (28) fait avancer ledit premier élément de mâchoire (22) vers ledit deuxième élément de mâchoire (20) sur une distance initiale suivie d'une deuxième distance, ladite distance initiale étant plus grande que ladite deuxième distance.

8. Appareil selon l'une des revendications précédentes, où ledit deuxième élément de mâchoire (20) comporte soit une surface d'enclume pour porter contre lesdites attaches ou un moyen pour tenir une pluralité d'éléments de retenue comportant des moyens pour recevoir les attaches.

9. Appareil selon la revendication 1, dans lequel ledit moyen d'avance (28) peut coulisser linéairement et comporte un élément de tige (40, 108) s'étendant distalement à travers un boitier dudit appareil et étant actionnable par le pouce (26, 102) par un opérateur pour faire avancer ledit premier élément de mâchoire.

10. Appareil selon la revendication 9, où ledit élément de tige est entaillé pour fournir une meilleure surface de préhension audit moyen de retenue pour retenir ledit élément de tige.

11. Appareil selon la revendication 9 ou 10, dans lequel ledit élément de tige se termine dans ledit boîtier dans une structure de bielle (110), ladite structure de bielle comportant plusieurs éléments de bras pivotants (112) aptes à être pliés pendant l'avance dudit moyen d'avance pour faire avancer ledit premier élément de mâchoire vers ledit deuxième élément de mâchoire, lesdits éléments de bras pivotant autour d'éléments de montant (114, 115) pour plier ladite structure et pour reformer ladite structure pendant un mouvement de va-et-vient dudit moyen d'avance.

12. Appareil selon la revendication 11, comportant en outre un mécanisme de coulissement de bielle (108) pour plier ladite structure de bielle pour faire avancer ledit élément de tige afin de solliciter ledit premier élément de mâchoire vers ledit deuxième élément de mâchoire, ledit mécanisme de coulissement comportant au moins une surface de came (126) pour venir en prise avec ladite structure de bielle.

13. Appareil selon la revendication 12, où ledit mécanisme de coulissement s'étend au-delà dudit boitier dudit appareil et se termine par un élément formant bouton poussoir (102).

14. Appareil selon la revendication 12 ou 13, dans lequel ledit moyen de retenue (122) est accouplé audit moyen d'avance (116) de telle sorte que ledit moyen de retenu se déplace dans ledit boitier lors du déplacement dudit mécanisme de coulissement, un moyen (106) étant prévu pour mettre hors prise ledit moyen de retenue afin de ramener ledit appareil à une position de repos.

15. Appareil selon l'une des revendications précédentes, où ledit moyen de mise hors prise comporte un élément de tige mobile (38) accouplé à un élément formant bouton poussoir (26), ledit élément formant bouton poussoir pouvant pivoter pour faire avancer ladite tige mobile pour venir en contact avec et désengager ledit moyen de retenue afin de ramener ledit appareil à ladite position de repos.

16. Appareil selon l'une des revendications précédentes, où ledit moyen de retenue comporte un élément de serrage pivotant (68, 122).

17. Appareil selon la revendication 16, où ledit moyen d'avance comporte en outre une tige de guidage stationnaire (36), ledit élément de serrage pivotant (68) étant fixé de manière coulissante à ladite tige de guidage stationnaire de telle sorte que ledit élément de serrage se déplace le long de et retient relâchablement ladite tige de guidage pour positionner sélectivement ledit moyen d'avance et lesdits éléments de mâchoire.

18. Appareil selon la revendication 17, où ledit élément de serrage pivotant a un perçage central (128) à travers lequel passe ledit moyen d'avance (36), et un bord dudit perçage central venant en prise avec ledit moyen d'avance pour retenir ledit moyen d'avance et pour positionner sélectivement ledit premier élément de mâchoire relativement audit deuxième élément de mâchoire.

19. Appareil selon la revendication 16, 17 ou 18, où ledit élément de serrage est sollicité vers une position en prise de telle sorte que ledit élément de serrage se situe suivant un angle audit moyen d'avance et comportant en outre un moyen de relâchement (73, 74, 78) pour dégager ledit élément de serrage dudit moyen d'avance.

20. Appareil selon l'une des revendications précédentes, dans lequel ledit moyen de retenue vient en prise avec ledit moyen d'avance, et le moyen de relâchement libère le moyen de retenue de prise avec le moyen d'avance.

Drawing